Membership Application

Kehillat Chovevei Tzion
PO Box 544
East Setauket, NY 11733
631-476-3623
http://www.kct.org

MEMBERSHIP APPLICATION

FAMILY NAME: ____________________________________________

FIRST NAME(S) (adults):

____________________________________________________________________________
(English) (Hebrew Name) (if male, Cohen of Levi?)

Other adults living in home:

____________________________________________________________________________
(English) (Hebrew Name) (if male, Cohen of Levi?)

Children:

____________________________________________________________________________
(English) (Hebrew Name) (Age) (if male, Cohen of Levi?)

ADDRESS:	___________________________________________________________________

	___________________________________________________________________

Telephone:

Email:

___________________________

_______________________________

Fax:

___________________________

When you are ready, please attach your deposit check to this completed form and mail to KCT at the above address. We look forward to many years together.